Finding a Doctor to Treat a Job-Related Injury
Many injured workers find it challenging to find a doctor they can trust to provide the necessary medical care to help them get better and get back to work. And, for good reason. An injured worker’s right to select the doctor may be limited in some cases. Therefore, it is imperative to understand the specific rules that need to be followed in designating a primary treating physician for medical treatment after an industrial-related injury.
Pre-designation of Personal Physician
There are times when an injured worker can receive medical care from his or her personal doctor after a work injury. This is called "pre-designation." There are specific requirements to pre-designate a physician, that, if followed, can enable an injured worker to see this doctor right after an injury without the needing an initial consultation with the company doctor. Furthermore, the injured worker is not required to select a doctor within the employer’s control.
Medical Provider Network (MPN)
A Medical Provider Network (MPN) is a list of doctors and other healthcare providers selected by the employer or insurer to provide medical care for injured workers. All MPNs must be approved by the state Division of Workers’ Compensation. There is no single MPN for the state, but instead there are different MPNs depending on the employer and insurance company. In California, there are more than 500 approved MPNs. In some cases, no MPN exists, which will be discussed below.
If an employer provides Workers’ Compensation medical care through an approved MPN, the injured worker must select a treating doctor from the network’s approved provider list if the worker was properly notified of the MPN and had appropriate access to the doctors on the list. Generally, an employer that participates in an MPN must give written information about the MPN to every employee 30 days before the MPN is implemented, when the employee is hired, and again when a worker gets hurt on the job. The employer is to schedule the initial evaluation with an MPN doctor after the date of injury. Thereafter, if the injured worker is not satisfied with the medical care from that doctor, the injured worker can designate a new doctor within the MPN to take over medical care.
In 2013, the rules and regulations concerning MPNs and MPN physicians are being reconsidered, and the rules may be altered over the course of the next few years.
No MPN, No Pre-designation
If an employer does not participate in an MPN, an injured worker can pick any doctor (who is willing to provide medical care in the Workers’ Compensation system) after 30 days from the employer’s receipt of the Employee Claim Form.
Regardless of how an injured worker selects a doctor, it is important that the doctor providing medical care has a clear understanding of the Workers' Compensation laws and understands the reporting requirements and the process necessary to request medical treatment. For example, after January 1, 2013, all doctors must request medical treatment authorization using a specific form, called a Request for Authorization. Failure to make the request utilizing this new procedure and form will jeopardize the injured workers’ right to receive medical care timely.
It is extremely important for an injured worker within the Workers' Compensation system to receive the best medical treatment as early as possible. Selecting the "wrong" doctor often leads to inadequate treatment that can often delay recovery. Even with a capable and dependable treating physician, there can often be delays in receiving medical care due to disputes that arise regarding medical treatment recommendations.
A skilled Workers’ Compensation attorney who is familiar with the complicated Workers' Compensation medical process can assist in selecting a doctor that fits an injured worker’s needs, and can assist when medical treatment disputes arise.
The attorneys at Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP (GEK) are experienced and knowledgeable about the specific rules, timelines and exceptions involved in the Workers’ Compensation medical system. If you would like to speak to a GEK attorney about your legal options, please call 213-739-7000 or click here.